Recommendations for a better understanding of sex and gender in neuroscience of mental health

Abstract

There are prominent sex differences in the prevalence of numerous mental health and neurodiverse conditions. Both sex and gender related factors affect the expression and diagnosis of mental health conditions. Even though, sex and gender research has been integrated in research policies, the underlying mechanisms and interactions between them are still not fully understood. This lack of knowledge has harmful consequences for diagnosis and treatment of mental health conditions. Hence, we have set up a co-creation session in a one week workshop, including a multidisciplinary team of 25 scientists, clinicians and policy makers, to identify the main barriers in sex and gender research in neuroscience of mental health. We provide recommendations and solutions for three focus areas including neuroscientific methods, bridging the gap between research and the clinic, and stakeholder collaborations. These recommendations include guidelines for documenting sex and gender methods and results, analysis beyond the binary and open science, which will drive our understanding of sex and gender related mechanisms in neuroscience. This will ultimately benefit public health as this is an important step towards precision medicine and may function as an archetype for studying diversity.

Making Sense of Sex in Neuroscience

“…Building upon previous commentaries, reviews ( 1 , 2 ), and calls to action ( 3 ), the recommendations put forward by Wierenga et al. ( 4 ) make the case for a concept of neuroscience that acknowledges and addresses the role of biological sex and the role of socially constructed gender. (As defined by the American Medical Association, “sex” is the classification of living things as male or female and is a biological component, defined via the genetic complement of chromosomes, including cellular and molecular differences.…”

“…Embracing the full complexity of brain differences between females and males, and between women and men, was a designated aim of the participants of the Lorentz workshop that spawned the present comprehensive guide ( 4 ). This endeavor necessitates the consideration of developmental aspects, spanning from prenatal influences through transitional periods, triggered or accompanied by endocrine changes, to age-related decline ( 1 ).…”

“…Wierenga et al. ( 4 ) mention that precision medicine will benefit from the investigation of sex and gender in neuroscience and mental health research. Taking into account an individual’s specific makeup in terms of genetics, biomarkers, phenotype, and psychosocial characteristics, precision medicine targets the optimization of the effectiveness of disease prevention and treatment and at the same time the minimization of side effects in individuals who are less likely to respond to a certain therapy.…”

“…The diagnosis and management of disorders, as well as gender equity in health care, will be promoted by decision making that is sex- and gender sensitive. To pursue the visionary aim of personalized medicine in brain-related health care, much more effort needs to be devoted to the role of sex and gender in disease etiology, diagnostics, and interventions, as well as with regard to the development of novel drugs and technologies; the recommendations outlined here ( 4 ) and in related publications ( 1 , 2 , 3 ) are an important step in this direction.…”

“…In this context, Wierenga et al. ( 4 ) stress the importance of stakeholder involvement and science communication. Sharing the authors’ White, cisgender, European background, we agree that the cultural and social/societal setting needs to be addressed when sex and gender are being discussed.…”